Anaesthesiology intensive therapy最新文献

Remimazolam is a novel, ultra-short-acting benzodiazepine that has emerged as a promising agent in modern anesthetic and intensive care practice. This review pre-sents a detailed analysis of its pharmacokinetic and pharmacodynamic properties, clinical efficacy, and safety profile across various patient populations and procedural contexts. The drug's rapid metabolism by plasma esterases, minimal reliance on hepatic or renal function, and availability of a reversal agent (flumazenil) distinguish it from traditional sedatives such as propofol and midazolam. Clinical data support its utility in procedural sedation, general anesthesia, and ICU sedation, particularly in elderly and hemodynamically unstable patients. Pediatric applications are discussed, highlighting the early evidence and dosing considerations. The review also compares remimazolam with other agents such as propofol and dexmedetomidine, underlining its advantages in cardiovascular stability and recovery profiles. While current results are encouraging, the article emphasizes the need for further research to establish standardized protocols and explore its long-term safety, especially in vulnerable populations.

Introduction: Second-generation supraglottic airway devices, such as the laryngeal tube suction disposable (LTS-D) and i-gel, are widely used in pediatric anesthesia due to advantages such as improved sealing and gastric drainage. This randomized controlled trial compared the efficacy and safety of the LTS-D and i-gel in non-paralyzed pediatric patients under general anesthesia.

Material and methods: Eighty ASA I children aged 2-8 years (12-25 kg), scheduled for short elective surgical procedures, were randomized to the LTS-D (n = 40) or i-gel (n = 40) group. Primary outcomes were oxygen saturation (SpO₂) and end-tidal CO₂ (EtCO₂). Secondary outcomes included insertion time, oropharyngeal leak pressure, fiberoptic view, tidal volumes (Vt), and adverse events.

Results: Both devices maintained comparable oxygenation. Mean EtCO₂ was slightly higher in the i-gel group, with a mean difference of 2.56 mmHg (95% CI: 1.86-3.26; P < 0.001). The i-gel had significantly faster insertion times (24.53 ± 2.00 s vs. 31.20 ± 1.95 s; P < 0.001) and superior fiberoptic visualization (optimal grades in 99% vs. 70%; P < 0.001). The LTS-D showed higher oropharyngeal leak pressures (37.63 ± 3.71 cmH₂O vs. 24.43 ± 1.72 cmH₂O; P < 0.001). Vt and adverse event rates were similar, with no severe complications reported (P = 0.65).

Conclusions: Both the LTS-D and i-gel are safe and effective for airway management in non-paralyzed children undergoing short procedures. The i-gel enables faster insertion and better anatomical positioning, while the LTS-D offers higher leak pressures, making it preferable when a better seal is needed. Device choice should be guided by clinical context and patient characteristics.

Introduction: The effect of modifying the end inspiratory pause (EIP) on the variations in the physiological dead space (VDphys) in patients undergoing robotic surgery ventilated under a tailored open lung approach has not been addressed before.

Material and methods: This prospective-paired study was carried out in a tertiary hospital. Following an alveolar recruitment manoeuvre (ARM) and the application of a tailored open-lung positive end-expiratory pressure (PEEPOL), participants consecutively received three EIP levels (30%, 40%, and 10%). The sequence was repeated after pneumoperitoneum and the Trendelenburg position and following a second ARM for patients with suspected lung collapse based on an Air test.

Results: Eighteen adult subjects were included. The use of an EIP of 10% was asso-ciated with a higher VDphys, both before pneumoperitoneum: 210 mL (IQR 200-237) vs. 197 mL (IQR 173-217) and 196.8 (IQR 185-218) with EIP 30% and 40%, respectively (P < 0.001 and P = 0.006) and after pneumoperitoneum: 212 mL (IQR 198-228) vs. 202 mL (IQR 181-213), P = 0.001. The application of ARMs and PEEPOL led to a significant reduction in driving pressure [5 cmH₂O (IQR 5-6) vs. 7 cmH₂O (IQR 6-10), P < 0.001], despite concurrent increases in PEEP [12 cmH₂O (IQR 10-13) vs. 5 cmH₂O, P < 0.001] and plateau pressure [17 cmH₂O (IQR 16-19) vs. 12 cmH₂O (IQR 12-15)].

Conclusions: The use of an EIP of 30-40% compared to 10% in patients undergoing robotic surgery optimises lung mechanics and minimises ventilation inefficiencies both before and during the establishment of pneumoperitoneum and Trendelenburg positioning.

An increasing number of patients treated with novel antidiabetic drugs, including glucagon-like-peptide-1 receptor agonists (GLP-1RA), dual glucose-dependent insulinotropic polypeptide receptor agonists and sodium-glucose cotransporter-2 (SGLT2) inhibitors, are presenting in the perioperative period. GLP-1RAs are known to delay gastric emptying, although current data remain preliminary and somewhat conflicting. SGLT2 inhibitors may be associated with euglycemic ketoacidosis in the perioperative period. To assess residual gastric content, gastric ultrasound may serve as a valuable tool in stratifying aspiration risk. Various recommendations are available for the perioperative management of patients on GLP-1RAs or SGLT2 inhibitors. These are based largely on expert opinion and multi-society consensus. This review aims to summarise the key perioperative considerations related to these drug classes and to familiarise practitioners with their pharmacological profiles. We highlight their potential adverse effects and present current recommendations from professional organisations to support safe and effective perioperative management.

Introduction: Neuropathic pain (NP) arises as a direct consequence of a lesion or disease affecting the somatosensory nervous system. Antidepressants (ADs) are recommended for the pharmacological treatment of NP. However, current guidelines do not specify how long ADs may be effective in NP treatment if the patient is benefiting from the therapy.

Material and methods: This was a retrospective cross-sectional study aiming to analyze the effectiveness of ADs in the treatment of NP by assessing the relationship between AD usage, the length of AD treatment and the intensity of pain in this group patients. Based on their pain intensity and length of treatment, the patients were divided into: three groups (NRS 0-3, NRS 4-6 and NRS ≥ 7), and six groups (< 1 month, 1-3 months, 3-6 months, 6-12 months, 1-2 years, 2-5 years, and > 5 years), respectively.

Results: The study was conducted on a database from 421 patients, 231 (54.86%) of whom took antidepressants. We found that AD treatment significantly reduces the likelihood of being in the NRS 7-10 group compared to the NRS 0-3 group (OR = 0.611, 95% CI: 0.37-1.0, P = 0.05), and this reduction was observed up to 24 months of treatment (OR = 0.41, 95% CI: 0.22-0.75, P < 0.004).

Conclusions: Considering the limitations of the study, the use of ADs in NP therapy may have a significant impact on reducing the occurrence of severe pain up to 24 months of therapy and should be included in pharmacotherapy in this group of patients.

Introduction: Peripheral venous catheter (PVC) insertion is a common intervention, conventionally performed using visualization and palpation techniques. It has been reported that the first attempt success rate can be as low as 51%. Ultrasound guidance improves the overall success rate and the success rate of the first attempt. Therefore, we performed a randomized, prospective, clinical trial to compare two different techniques of PVC insertion in the setting of an operating theatre with a focus on the first attempt success rate.

Material and methods: This clinical trial allocated patients scheduled for elective surgery in general anaesthesia to undergo PVC cannulation with ultrasound guidance (Group A) or to undergo PVC cannulation without the use of ultrasound (Group B).

Results: A total of 613 adult patients were enrolled. The success of the first cannulation attempt was significantly higher in Group A compared to Group B (Group A: 90.6%, Group B: 84.5%, P = 0.039). The overall success rate in both groups was 100%. The time needed to perform PVC cannulation was significantly lower in Group B than Group A (Group A: 406 ± 200 s, Group B: 301 ± 215 s, P < 0.001).

Conclusions: We found that ultrasound-guided PVC cannulation was associated with a higher first-attempt success rate than the conventional technique.

Introduction: The aim of the study was to evaluate the neurocognitive safety of two schemes of general anesthesia based on propofol or sevoflurane applied to patients undergoing laparoscopic gynecological operations, with a special focus on the patients' age, American Society of Anesthesiologists (ASA) physical status/risk category I, II, or III, and levels of neuromarkers.

Material and methods: The Montreal Cognitive Assessment (MoCA) was chosen for cognitive assessment. The potential neuroinjury after anesthesia and operation was assessed with a set of neuromarkers: glial fibrillary acidic protein (GFAP), neurofilament light chain (NFL), tau protein (tau), and ubiquitin C-terminal hydrolase L1 (UCH-L1). The study was conducted on a group of women with no prior neurological or psychiatric diseases.

Results: A total of 61 patients (mean age 40.57 years) were included in the study (29 patients under propofol-based anesthesia [PBA], 32 patients under sevoflurane-based anesthesia [SBA]). The groups were demographically comparable. The patients in both groups exhibited a postoperative increase in the MoCA regardless of the type of anesthesia. The NFL and UCH-L1 levels increased significantly in both groups. The GFAP levels were significantly higher in the SBA group. Neither the age nor the increase in the neuromarkers influenced the patients' cognition.

Conclusions: The types of anesthesia applied in the laparoscopic gynecological operations resulted in a cognitively safe outcome despite detectable alterations in the neuromarkers.

Introduction: Total knee arthroplasty (TKA) is associated with severe pain. We examined whether an ultrasound-guided, single-injection L2 erector spinae plane block could improve analgesia compared to an ultrasound-guided iPACK (infiltration between the popliteal artery and capsule of the knee) block with adductor canal block (ACB) in patients undergoing TKA under spinal anesthesia.

Material and methods: Ninety patients aged 65-89 years of both sexes (ASA I-III) scheduled for TKA were randomly allocated to receive iPACK block (ropivacaine 0.2%, 20 mL) with ACB (ropivacaine 0.2%, 10 mL), lumbar erector spinae plane block (L-ESPB) (ropivacaine 0.2%, 20 mL on each side), or to the control group. The primary outcome was total opioid consumption. The secondary outcomes included pain scores, time to first rescue opioid analgesia, quadriceps muscle strength, neutrophil-to-lymphocyte ratio (NLR), and platelet- to-lymphocyte ratio (PLR).

Results: The total opioid consumption in 48 h was significantly lower in the iPACK+ACB group (mean ± SD) (3.0 ± 3.3) compared to L-ESPB (6.8 ± 3.8, P = 0.0442) and the control group (18.2 ± 4.0, P < 0.001). The time to first rescue opioid analgesia was longer in the iPACK+ACB (12.0 ± 1.9) compared to the L-ESPB (9.2 ± 1.9, P < 0.001) group and the control group (4.3 ± 1.1, P < 0.001). The pain scores, NLR, and PLR levels were significantly lower in the iPACK+ACB and L-ESPB groups than at all time points in the control group.

Conclusions: The iPACK+ACB is more effective than L-ESPB in pain management following TKA. iPACK+ACB and the L-ESPB lowered total opioid consumption and prolonged time to first opioid analgesia. NLR and PLR levels did not differ between the groups.

In Poland, epidural analgesia in labour is reimbursed from public funds by the National Health Fund, and yet many women are still unable to access it. The main factor limiting the accessibility of this procedure is the lack of an anaesthesiologist. Compared to other fields of medicine in which anaesthesiologists are involved, the needs of women giving birth are often marginalized and do not constitute a priority for the managers of medical entities. In 2022, 14% of births took place under analgesia, rising to 17% in 2023, and 23% in 2024. Despite the positive trend, still, on average, only one in four women can count on giving birth without unnecessary suffering. The aim of the article is to review the current legal ramifications of labour analgesia in terms of international, European, and Polish law.